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otolorin

Anti-depressants in the management of parkinson disease anxiety

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Hi,

I researched an article which stated that anxiety in parkinson,is complex. pwp could have anxiety as a symptom of pd,side effects of pd meds,or anxiety about future complications of pd.Most MDs will prefer antidepressants to benzodiazepines,due to the long acting effect.But at the same time,some of these antidepressants do not work ,or only work on a short term,then the MD would have to switch to another type of antidepressants.I know that depending on the genetics,some medication might work for some people and do not work for others.Should't there be a way for MD's to know if a particular antidepressant will work for a pwp?Since pwp often deal with a complexity of anxiety situations.What will be your best choce of antidepressant medication for a pwp?Please take into consideration the side effects,when making your choice,as some pd meds already have some similar side effects with antidepressants and the additive effects might be overwhelming.Thanks for your anticipated response.

 

 

Edited by otolorin
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Otto,

There is really no sure fire way to choose an antidepressant specific for are Parkinson's patients. Most Dr's work off past experience as to what may work best for a particular patient. The problem that may exist sometimes is that the depression can be organic (already within the person's mind) or brought on by PD.

I usually see Dr's trying the newer antidepressants first due to the less incidence of side effects and that smaller doses are showing to be more effective than larger doses of older medications. 

As far as choices of antidepressants used in people with Parkinson's that have depression and anxiety are usually:

(1) SSRI's (Selective Serotonin Reuptake Inhibitors):

     Celexa (Citalopream)

     Lexapro (Escitalopram)

     Paxil (Paroxitine)

     Prozac (Fluoxitine)

     Zoloft (Sertraline)

(2) SNRI's (Serotonin Norepinephrine Reuptake Inhibitors):

     Cymbalta (Dulaxitine)

     Effexor & Effexor ER (Vanlafaxine & Vanlafaxine ER)

     Pristiq (Desvenlafaxine)

(3) Atypical (Because their Mechanism of action does not fir into any other group)

     Desyrel (Trazadone)

     Remeron (Mirtazapine)

     Wellbutrin & Wellbutrin SR (Buproprion & Buproprion SR)

This is usually the order in which they are tried in most patients and also based on the Dr's previous experience with the medications. All of these antidepressants work on both depression and anxiety. Their are certain circumstances where the anxiety is too much to be controlled by a certain antidepressant. At this point it will be at the Dr's discretion as to choose to add a Benzodiazipine, such as Ativan (Lorazepam), Klonipin (Clonazepam), Librium (Chlordiazepoxide), Valium (Diazepam), or Xanax (Alprazolam). Depending on the situation the Dr may add an antianxiety medication with the antidepressant or decide to withdraw the antidepressant and solely use the antianxiety medication.

I many patients I will use a scenario of relieving headache pain. To make it simple, I will say that there are basically 3 options: Tylenol (Acetaminophen), Motrin or Advil (Ibuprofen), and Bayer (Aspirin). People who have Liver issues will want to stay away from Tylenol (Acetaminophen) due to the fact it is broken down by the liver. If a person has stomach issues such as ulcers or sensitive stomachs, they will want to sty away from Motrin or Advil (Ibuprofen) because it is very tough on the stomach. Lastly, if a person has an issue with blood thinners or sensitive stomachs, they will want to stay away from Aspirin.

As yo can see many issues are involved in choosing just a pain medication, the choice of an antidepressant that helps with anxiety could choose to be an even tougher decision.

I hope this help and please keep me posted.

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I guess,we patient's just have to continue to try meds and see,which ever works for our situation.Thanks for your response,and God bless.

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It may seem that it may be a hit or miss, but most Dr's will choose the best possible medication for your situation.

I hope this helps and please keep me posted.

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